Primaries, too close, and when/how to get out

[umcRN, BSN, RN]

This is Long! Sorry!

Ugh, so I am trying to figure out what to do in this situation. I have a primary, I've had her for about 4 weeks now. I have only had one other long term primary (he was and is still my one and only true love :heartbeat ) and the primaries I typically sign up for are my "favorite" kind of babies, big, pphn/cooling, sick as snot for a week or two and then go home! Those are my favs. Anyways I took care of this one baby 4 weeks ago who, per report had "difficult" parents (they are, for the record) and the baby was super sensitive, sick, etc but it seemed like things were headed in the right direction for her and while her parents are hard, I've gotten along great with then and they really like me, which obviously makes the job easier. Anyways she was close to getting home when she broke Pulmonary hypertension, now I work in a large level III/IV whatever you want to call it facility and we get these phtn kids all the time, usually they end up chronic, or worse, dead.

So now I am primary for this baby who I am in love with, who I have seen close to death, get better, and over the last week and a half deteriorate before my eyes. Today she coded at shift change, I had already signed out but of course I was the next closest to her room besides her nurse who had been in there already so I was in there, flattening her bed, grabbing her bag, turning on the nitric, calling the doc, resp, and finally hitting the code button (worst time ever to code, shift change because EVERYONE - docs, RT, charge RN, is in report). Mom is in the room crying (last time she saw something like this was prior to her initial sickness that got her to our unit, and she almost died, chest compressions, epi, etc), dad is trying to hold her arms/legs down so the nurse can bag her (she is not currently intubated), its chaos. I found myself going through the motions, bag, get help, chest compressions, but in my head I was screaming "not my baby, not my baby, not my baby" I was looking out for her mom, making sure she wasnt passed out, and was giving the docs all the info on how her day was, last blood gas, etc

Here's the thing though, shes NOT "my" baby, I am still shaking at home and this is not my first patient to code, I am worried about her parents, about her, I am resisting every urge to call and check on her. I don't think emotionally I can watch her and her mom (ok, dad too but he is the difficult, pain in the a** on that makes the days long and difficult) go through months of critical sickness, of the codes, of the heavy sedation and minimal stimulation that goes along with pulm hypertension, and if she were not to survive I don't think i could see them through that.

I am torn because I think I need to stop being her primary because of this but every day her mom and dad call me her "angel", I know her, I have a routine with her and we "generally" have good days (obvi today didnt end well), she only has one other primary because, as I said, they are very difficult, the baby is not easy either and nurses quickly ask not to take care of her again so other than me and her other primary (and of course we are both on days) she is rotated around through everyone (in my unit RN's sign up for primaries, we are not assigned and every baby does not have one) and her parents do not do well with all the different nurses and do not trust easily (and i have spoken with them about this many times, they are aware that they are difficult).

Ugh! I am sorry, now I am venting so much but I would feel terrible seeing her parents every day and telling them I took my name off the list, but I also don't know if I can handle going through this with her, pulmonary hypertension is a nasty thing and we've had too many casualties from it. And as it is I told her mom I would sign up for extra the day of her cardiac cath, ugh! What to do!?

[NicuGal, MSN, RN]

I've been in your shoes, more than once. I'm sorry You need to step back for a little bit....talk to you manager and your CNS about it.

First...you need to stop signing up to be there when they do things with the baby, you have a life outside of work, and you need the time off to cool off. Second, ask to be assigned to other patients...kids like this drain the life out of you. Sure, people are going to tell you that you are the primary, etc and that the parents only like you, but stand tough. You are going to burn out. And you reserve the right to tell the parents that you are taking a break for a week or two. And I am sure they will play the your-the-only-one-we-like card and then be mean to others, but that is how it goes.

Remember, you have to take care of you...and you need a break to get your head on straight about this. It sucks, it is part of our work, but your co-workers need to step up, esp if you are as stressed as it sounds.

[dawngloves, BSN, RN]

It's OK to take a break from your primary. Sometimes it helps if you come back to a pt after a couple of weeks. You get a different perspective, you are more centered. And someone may care for her in that time that has different perspective. Beneficial all around.

[Imafloat, BSN, RN]

This is why I hesitate to sign up for primaries. I was in a similar situation once and I stuck it out. I felt that if I felt that bad, the parents felt even worse and me leaving them was going to make things even harder on them.

What I did was volunteer to float for a few shifts, it got me out of the unit and away from the situation.

My baby's parents weren't high maintenance, that is a big difference from your situation.

You are ultimately going to have to decide what you need to do, it's your life and you have to decide what's best for you.

[umcRN, BSN, RN]

Thanks for the great and understanding replies. I do feel I'm too emotionally wrapped up in the situation, and like today, when the parents come back from taking a few hours off because I'm here and they "trust me enough to leave" (and they NEVER EVER leave), I had to tell them we had a bad afternoon, not just a bad afternoon, a really really bad afternoon, it breaks my heart to even get the words out, but I'm not going to sugarcoat it either. And when we're about coding her and the doc looks to me and says "im sorry i don't know what else to do" i'm crying/screaming inside and getting frustrated with her because she's supposed to be the one with the answers

The way things are going now I likely won't be caring for her much longer, and not because i'm going to take my name off the list, i feel like at this point i have to stick it out for them but work on detaching myself from the situation a little better, for instance i work tomorrow but then not again till Sunday, and while we are short and using extra, I will not be signing up for it. She does have one other primary who will be there Friday and if it all hits the fan Saturday...well maybe that would be better, as much as I hate and feel guilty saying that

I guess i initially thought this might be a weeks to months situation but unless she turns out to be one of those kids that could be hit by a train and still live (and every unit has one or two of those!), she's probably going to be gone pretty soon

[umcRN, BSN, RN]

My sweet baby got her wings today Thanks for all of the advice, but I am glad I was her nurse the last three days

[rockabye]

It's difficult to see a primary take a turn for the worse and continue to care for that baby knowing the chances of survival are slim. I felt really bad for a former primary of mine and couldn't help think about him on my days off. I don't regret being there for him or his family when it was time for his wings either. It was a great learning experience for me and I felt like it was a critical point in my nursing career having taken care of him for all those months during his multiple high and low periods. I had a lot of invested emotions taking care of him and, after he passed, what helped me was that I stopped working overtime shifts for awhile and didn't pick up another primary for about 1 year. I hope your stress has improved and I congratulate you for sticking with your primary and his family because I am sure they were glad you were her nurse the last 3 days too. ((HUGS)) :heartbeat

[umcRN, BSN, RN]

It's difficult to see a primary take a turn for the worse and continue to care for that baby knowing the chances of survival are slim. I felt really bad for a former primary of mine and couldn't help think about him on my days off. I don't regret being there for him or his family when it was time for his wings either. It was a great learning experience for me and I felt like it was a critical point in my nursing career having taken care of him for all those months during his multiple high and low periods. I had a lot of invested emotions taking care of him and, after he passed, what helped me was that I stopped working overtime shifts for awhile and didn't pick up another primary for about 1 year. I hope your stress has improved and I congratulate you for sticking with your primary and his family because I am sure they were glad you were her nurse the last 3 days too. ((HUGS)) :heartbeat

Thanks, glad I'm not the only one who worried about my baby on my days off. I am definitely planning a long break from having primaries. It was just such a shock to everyone, two weeks ago she was hanging in her bouncy seat smiling at everyone who walked by her room (She was five months, full term). And now shes gone, and the end was very very fast, she blew a pneumo after a bad night of coding and bagging and her parents (who have been there through every pulm hypertensive crisis, code, procedure, etc) made the decision not to put her through a chest tube, and that was it. Parents were devastated but I am glad I was there to support them, her other day shift primary was also on that day and helped as well. It was a long day but I hope I was able to make it as "good" an experience as possible for her parents, not that that experience could ever be a good one but you get what I mean.